Published as a practice bulletin for doctors called Management of Menopausal Symptoms, the new guidelines recognize that up to three-fourths of women in the United States experience troublesome side effects when their bodies stop producing estrogen as a result of natural or medically induced menopause. The document addresses the most common distressing consequences: hot flushes and vaginal atrophy.
Hot flushes can last for months or even decades, but vaginal problems, if untreated, persist for the remainder of a womans life.
Hot flushes can cause drenching, sometimes embarrassing sweating, and seriously disrupt sleep night after night. Vaginal atrophy and the loss of lubrication and elasticity can make sexual encounters painful, depress libido and cause irritation and bleeding during exercise.
You might think the standard treatment would be to administer the hormones that menopausal women are losing. Indeed, supplementation with estrogen was a common practice for decades, and not just for curbing menopausal symptoms. Estrogen was widely promoted as a way to protect womens health and to keep looking and feeling young well into old age.
But in 2002, a large clinical trial called the Womens Health Initiative found that the most popular form of hormone replacement, a pill that combined estrogen and synthetic progesterone called Prempro, increased a womans risk of heart disease, breast cancer, stroke and blood clots.
The new bulletin, prepared by Dr Clarisa R Gracia, an associate professor of obstetrics and gynaecology at the University of Pennsylvania, examines the various claims and scores of studies. It offers treatment recommendations based on the best available evidence for preserving the health and well-being of women experiencing menopausal symptoms.
But most women do best when their physicians offer remedies that have been shown to be effective in well-designed studies. And as you might guess, estrogen alone, or in combination with a natural or synthetic progesterone (progestin) for women who still have a uterus, is the most effective therapy for curbing hot flushes, the report found.
Data do not support the use of progestin-only medications, testosterone or compounded bioidentical hormones, the report also said.
Estrogen with or without progestin can be administered orally or through the skin with a patch, gel or spray. The transdermal route is considered safer: When absorbed through the skin, hormones bypass the liver, which would otherwise create substances that might raise the risk of heart attack or cancer.
The report emphasises that treatment with hormones must be individualized and that doctors should prescribe the lowest effective dose for the shortest time needed to relieve hot flushes.